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WCF > Caring for Child w/ Resp. Condition > Flashcards

Caring for Child w/ Resp. Condition Flashcards

1
Q

-Narrow airway
-Nonproductive cough & little mucous
-Belly breathers til age 6
-Lymphoid tissues absent til age 7
-Epiglottis is long & flaccid til age 8
-Epiglottis is U-shaped
-Larynx & glottis is higher in the neck
-Thyroid/cricoid/tracheal cartilage are immature
-Neck has fewer muscles

A

Infant

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2
Q

-Rapid growth and expansion of alveoli
-Lung development complete by age 5/6
-Right bronchus shorter, wider, and more vertical
-Frontal and sphenoidal sinuses are developed

A

Toddler & school-age

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3
Q

What is the purpose of the eustachian tube?

A

-Reduces pressure
-Drains fluid from middle ear

More difficult to do these things in children because of shape (more horizontal than in adults)

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4
Q

Health history information to obtain during assessment

A

-allergies
-immunizations utd?
-number of colds/year (6-8 is typical)

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5
Q

Risk factors for respiratory distress

A

-congenital heart defects
-immunosuppression
-premature birth
-genetic disorders
-environmental (smokers, exposure to illness, daycare)

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6
Q

Health O2 saturation for healthy infants and children?

A

95-100%

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7
Q

Levels of resp. distress

A

mild, moderate, & severe

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8
Q

Sx of mild resp. distress

A

-tachypnea
-tachycardia
-diaphoresis

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9
Q

Sx of moderate resp. distress

A

-nasal flaring
-retractions
-grunting
-wheezing
-anxiety, irritability, & mood changes
-headaches
-hypertension

will still see mild sx

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10
Q

Sx of severe resp. distress

A

-bradycardia
-stupor, coma
-cyanosis
-apnea/ALTE

will still see mild and moderate sx

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11
Q

Mild retractions

A

intercostal

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12
Q

Moderate retractions

A

substernal and subcostal

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13
Q

Severe retractions

A

supraclavicular and suprasternal

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14
Q

Irregular breathing with pauses <20 seconds

A

Normal resp. variation

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15
Q

-Pauses lasting >20 seconds
-Associated with cyanosis, pallor, hypotonia, and bradycardia
-May be 1st major sign of distress in newborn

A

apnea

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16
Q

-Color change, limp tone, choking/gagging
-Usually seen in infants under 2 months

A

ALTE (acute life threatening event)

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17
Q

Causes of apnea/ALTE

A

reflux, lower airway disorders, seizures, trauma, sepsis, or pertussis

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18
Q

Management of apena/ALTE

A

physical stimulation, resuscitation, and treating underlying cause

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19
Q

Airway positioning for resp. distress

A

-avoid flexion
-do not hyperextend neck
-support shoulders w/ towel (sniffing position)
-upright position/elevate HOB

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20
Q

Types of O2 tools

A

-nasal cannulas
-face mask
-blow by
-humidification
-bi-pap
-mechanical ventilation

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21
Q

Malformation of the posterior choanae in the nose causing a blockage
-can be bone or membranous
-can be both sides or unilateral

A

choanal atresia

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22
Q

S/sx of choanal atresia

A
  • Dyspnea
  • Cyanosis at rest
  • Difficulty eating (Choking, regurgitating food)
  • Unilateral choanal atresia may be asymptomatic unless child is sick
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23
Q

How is choanal atresia diagnosed and treated?

A

Confirmed w/ CT

Surgical correction- transnasal or transpalatal w/ puncture or stenting

Bilateral requires emergency surgery

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24
Q

Failure of esophagus to develop continuous passage to stomach
* Blind pouch

A

Esophageal Atresia (AE)

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25
Q

Portion of esophagus is connected to the trachea by a fistula causing abnormal communication between the two structures

A

Tracheoesophogeal Fistula (TEF)

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26
Q

S/sx of AE & TEF

A
  • Excess drooling/secretions
  • Frothing/bubbling
  • Cyanosis
  • Choking with feeding
  • Inability to pass OG/NGT
27
Q

How is AE & TEF diagnosed and treated?

A

Confirmed w/ prenatal ultrasound (no barium)

Surgical emergency to close fistula and join sections

If preemie/compromised surgery will wait until stable

28
Q

Barium can cause

A

defects and malformations

29
Q

Autosomal recessive abnormality on chromosome 7 that impairs movement of Cl- and Na+ within the cells, thickening secretions. Most commonly the respiratory biliary, pancreatic, and intestinal tracts. Diagnosed using sweat chloride test.

A

Cystic fibrosis (CF)

30
Q

What is the sweat chloride test: gold standard?

A

A mild electrical current pushes medicine into the skin causing sweating. Sweat is collected and salt content is measured.

Normal <40mEg/L
Suspicious 50-60mEg/L
Diagnostic >60mEg/L

31
Q

Systems affected by CF

A

Sinuses: sinusitis (infection)
Lungs: thick, sticky mucous buildup, bacterial infection, and widened airways
Skin: sweat glands produce salty sweat
Liver: blocked biliary ducts
Pancreas: blocked pancreatic ducts
Intestines: cannot fully absorb nutrients
Reproductive organs: male & female complications

32
Q

Airway w/ CF

A

-thick, sticky mucus blocks airway
-widened airway
-blood in mucus
-bacterial infection

33
Q

Most common cause of death for CF pts?

A

lung damage is the most common cause of death

34
Q

How to treat CF lung complications?

  • Mucous plugs cause air trapping and atelectasis
  • Chronic bacterial and fungal colonization progressively destroy lung tissue
  • Lung damage most common cause of death
A

-Airway clearance: chest physiotherapy and vests
-“Asthma” Medications + Pulmozyme (thins secretions)
-Yearly Tune-ups at the hospital
-Minimize exposure to illness
-CF patients should be separated by at least 6 feet from others with CF
-Exercise/Fitness

35
Q

How to treat CF digestion complications?

  • Clogging of pancreas ducts prevents pancreas from delivering digestive enzymes
  • Malabsorption-especially fats and proteins (steatorrhea)
  • Bowel obstruction due to thick mucous
A
  • Pancreatic Enzymes with meals/snacks
  • 110%-150% Calories with 35%-40% fat intake (increase calories and decrease fat)
  • ADEK vitamins
36
Q

How to treat CF skin complications?

  • Sweat gland malfunction leads to excess sodium & chloride in sweat
A

Salt tablets-may need during summer/exercise

37
Q

How to treat CF reproductive system complications?

  • Small stature
  • Delayed puberty
  • Vas deferens in males affected 95% of males are infertile
  • Dense vaginal and uterine mucus plugs may block sperm from being able to fertilize an egg (fertility issues)
A
  • Genetic counseling
  • Promote nutrition to encourage growth and development
38
Q

Sore throat

Commonly caused by:
Viral 85% -Commonly Adenovirus
Bacterial 15-25%
Group A beta-hemolytic strep (GABHS)~15-25%

A

pharyngitis

39
Q

S/sx of pharyngitis

A

Fever
Sore throat
Difficulty swallowing
Cervical adenopathy
Inflamed pharynx and tonsils
Abdominal pain

40
Q

Important points of pt education for pharyngitis

A

Take antibiotics as prescribed! (for bacterial)
Tylenol/Ibuprofen
Change toothbrush to prevent re-infection
Return to school after 24 hours of antibiotics

41
Q

What happens if antibiotics aren’t finished?

A

Bacteria will become resistant to antibiotic

42
Q

Tonsils secrete immunoglobins. Strep is most common cause.

A

tonsillitis

43
Q
  • Can be viral OR bacterial
  • Upper airway inflammation/swelling
  • Affects larynx, trachea, and bronchi
  • Edema/erythema of lateral walls of trachea below vocal cords
A

croup syndromes

44
Q
  • Viral etiology
  • Peak 3-36 mos.
  • URI
  • Seal-bark cough, worse at night
A

Acute Laryngotracheitis

45
Q
  • Viral etiology
  • Peak 3-36 mos.
  • NO URI
  • Sudden onset at night with barky cough
A

Spasmodic Croup

46
Q
  • Viral etiology
  • More common older children
  • Hoarseness
A

Laryngitis

47
Q

Management of viral Croup

A
  • Supportive care
    Fluids, Pain management, Fever management, Cool mist vaporize, & Steroids
  • Can usually manage at home
48
Q

Types of bacterial croup

A

bacterial tracheitis, epiglottis, & laryngotracheobronchitis

49
Q
  • Progressive illness over 2-5 days
  • Complication of viral disease or prior URI
  • Can lead to life-threatening airway obstruction
  • High Fever >102.2
  • Croupy cough
  • Thick, purulent secretions
  • Hoarseness
A

Bacterial Croup

50
Q
  • MOST Life-threatening
  • droplet precautions
  • Bacterial: H. Influenza, GABHS
  • Peak 1-5y
  • Rapid progression
  • High Fever 101.8-104
  • 4 D’s: Dysphonia, Dysphagia, Drooling, Distressed Resp Effort
  • TRIPOD position
  • Lateral neck x-ray will show a narrowed airway/round epiglottis- ”Thumb sign”
A

Epiglottis

51
Q
  • Bacterial: Staph A (can be viral too)
  • Peak 3-36 mos.
  • Acute onset
  • High Fever 102.2
  • Barky-seal cough
  • Hoarseness
  • Stridor and resp. distress
  • Chest x-ray will show a ”Steeple Sign”
A

Laryngotracheobronchitis

52
Q

Why should throat inspections/cultures be avoided in pts w/ epiglottis?

A

can cause spasms

53
Q
  • Direct contact w/secretions or contaminated surfaces
  • Annual epidemics October-March

Low grade-Moderate Temp
URI/cough May be dehydrated
Severe resp. distress
Adventitious lung sounds
Usually resolves 5-7 days

A

BRONCHIOLITIS/RSV
(Resp. Syncytial Virus)

54
Q

Infection of the pulmonary parenchyma (alveoli)

  • Retractions, nasal flaring, malaise, chest pain, poor appetite, adventitious or diminished sounds, abdominal distention & pain
  • Viral: Usually symptoms less severe
  • Bacterial: cough, dyspnea, tachypnea, adventitious breath sounds, grunting, retractions, toxic appearance
  • Mycoplasma: Common in pts with asthma
A

Pneumonia

55
Q
  • Highly contagious lung infection caused Bordatella Pertussis
  • Can be DEADLY to infants
  • Highest risk < 3 months
  • Signs and symptoms based on 3 stages
A

PERTUSSIS
(WHOOPING COUGH)

56
Q

Stages and sx of Pertussis

A
  1. Catarrhal Stage- Lasts 1-2 weeks: URI-Mild cough, coryza,
    and sneezing, low-grade fever < 101°F
  2. Paroxysmal Stage- Lasts 2-4 weeks: paroxysmal cough ending w/inspiratory whoop,
  3. Convalescent StageLasts 3 weeks-6 months: Cough less severe-whoops slowly disappear.
57
Q

Caused by any damage to the lungs- sepsis, viral pneumonia, smoke inhalation, drowning, or aspiration

A

Acute Respiratory Distress Syndrome (ARDS)

58
Q

How to prevent VAP (ventilator acquired pneumonia)

A

-Prevention bundle care if ventilated which includes mouth care, suctioning, HOB elevated, not dumping condensation into ventilator circuit

59
Q

Lung/bronchiole inflammation caused by a trigger that activates IgE antibodies
* Causes the airway to swell and mucus trapping

A

Asthma

60
Q

Asthma triggers

A
  • Environmental
  • Viral illnesses
  • Allergens
  • BPD (bronchopulmonary dysplasia)
  • Misc: fragrances, exercise, emotions, weather changes
61
Q

Severe s/sx of foreign body aspiration

A

cyanosis, drooling, dyspnea, forceful coughing, stridor, wheezing

62
Q

Blockage of the respiratory passage with either fluid or solid matter

Most common in toddlers

Severity depends on size of object and angle of placement inside the
passage

A

Foreign body aspiration

63
Q

Smoke inhalation requires

(Inhalation of smoke that is a mixture of gas and aerosolized matter)

A

emergency treatment that consists of stabilizing the airway and flushing excess CO2

WCF (12 decks)

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